Provider Demographics
NPI:1578772596
Name:TYABJI, ALIFIYA A (MD)
Entity Type:Individual
Prefix:
First Name:ALIFIYA
Middle Name:A
Last Name:TYABJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALIFIYA
Other - Middle Name:J
Other - Last Name:POONAWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10105 BANBURRY CROSS DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6646
Mailing Address - Country:US
Mailing Address - Phone:702-765-5437
Mailing Address - Fax:702-240-7268
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-765-5437
Practice Address - Fax:702-240-7268
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45229350Medicaid
NVCS15542OtherSTATE PHARMACY
NV12436OtherMEDICAL LICENSE
NV1578772596Medicaid
NV1578772596Medicaid
NVCS15542OtherSTATE PHARMACY